Welcome to The Arc of North Carolina.
Working with and for people with intellectual and developmental disabilities for over 50 years.

Wednesday, August 18, 2010

NCGA: Legislative Wrap Up #1

The short session was very short this year. Totaling only seven and a half weeks there was an abundance of policy changes that took place through bills and the state budget. This is the first of a series of posts that will guide you through what happened this session. The first and most difficult part of the short session was how to adjust the state's biennial budget. Here then is the budget wrap up.

Budget Background:

This year members of the General Assembly had to balance an 800 million dollar budget deficit as well as a possible 500 million additional deficit if FMAP was not extended.The key to this year’s budget was how to fill the gap without cutting critical services and without passing a comprehensive revenue/tax package. Overall the members of the appropriation committees did just that.

The final budget reflected very targeted cuts and very targeted expansions. Leadership on HHS appropriation in the House and the Senate did worked diligently to limit cuts for critical services. At the same time we did see targeted expansions in crisis beds and a restoration of the $40 million service dollar cut that was made in the previous budget to LME state dollar service funding.

A major area of concern for the developmental disability community was the full state expansion of the managed care model that is currently in use at PBH. During this session a broad coalition worked diligently to limit the expansion of the 1915 b/c waivers. The final special provision limited the expansion and also included language that directs the department to look at alternatives and to do a thorough customer service study of the existing and two new waiver sites.

As the budget and session came to a close it became clear that the US Congress was going to be unable to pass the necessary FMAP extension. During the last hours of the session a budget technical corrections bill was passed that included a list of eight proposed cuts to fill the 518 million dollar deficit caused by losing FMAP money. The cuts are proposed throughout the state system as opposed to only targeting Medicaid. The list is prioritized and includes language regarding the process of implementing the cuts depending on the amount of FMAP dollars received by the state.

Money Report:

Division Management Funds ($7,180,807)NR

Reduces unobligated funding available at the Division's discretion for

one-time needs of community providers or LME system needs.The total

includes $1,169,355 for mental health, $3,398,534 for developmental

disabilities, and $2,612,918 for substance abuse services.These funds

have historically been spent to address specific one-time needs; these

Increases funds available for the three-way contracts to purchase local

hospital bed capacity for crisis response within communities.These

funds will support additional community hospital beds, bringing the

total funding to $29 million annually.

Community Service Funds$40,000,000NRProvides funding for community services administered through Local Management Entities. This funding fully restores the mental health, developmental disabilities, and substance abuse services funding reduced for FY 2010-11.This amount includes $30,559,012 of funds transferred from Department of Public Instruction's Office of Early Learning.

Special Provisions:

CAP-MR/DD SERVICE ELIGIBILITY (Page 52)SECTION 10.7A.Section 10.21B of S.L. 2009-451 reads as rewritten: "SECTION 10.21BSECTION 10.21B.(a) Except as otherwise provided in this sectionsubsection for former Thomas S. recipients, CAP-MR/DD recipients are not eligible for any State-funded services except for those services for which there is not a comparable service in the CAP-MR/DD waiver. The excepted services are limited to guardianship, room and board, and time-limited supplemental staffing to stabilize residential placement. Former Thomas S. recipients currently living in community placements may continue to receive State-funded services.

"SECTION 10.21B.(b)The Department of Health and Human Services, Division of Medical Assistance, shall work with stakeholders to develop a new service definition within the CAP-MR/DD waiver to better meet the needs of individuals who (i) have a high intensity of behavioral needs, (ii) reside in small licensed residential placements, and (iii) require supervision 24 hours per day, seven days per week, three hundred sixty-five days per year. The Division shall apply to the Centers for Medicare and Medicaid Services (CMS) for an appropriate amendment to the CAP-MR/DD waiver if CMS approval is necessary to implement the new service definition. Not later than October 1, 2010, the Department shall report to the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services, the House of Representatives Appropriations Subcommittee on Health and Human Services, the Senate Appropriations Committee on Health and Human Services, and the Fiscal Research Division on the development of the new service definition and the status of any necessary approval from CMS to implement the new service definition."

STUDY MEDICAID PROVIDER RATES (page 67)

SECTION 10.25.(a)The Department of Health and Human Services, Division of Medical Assistance, shall initiate a study or contract out for a study of reimbursement rates for Medicaid providers and program benefits. The study shall include the following information:

(1) A comparison of Medicaid reimbursement rates in North Carolina with reimbursement rates in surrounding states and with rates in two additional states; and (2) A comparison of Medicaid program benefits in North Carolina with program benefits provided in surrounding states and with rates in two additional states. Selected provider rates shall be studied for the initial report.

SECTION 10.25.(b)The Department shall report its initial findings to the Governor, the Senate Appropriations Committee on Health and Human Services, the House of Representatives Appropriations Subcommittee on Health and Human Services, and the Fiscal Research Division by April 1, 2011.

SECTION 10.25.(c)Funds appropriated to the Department of Health and Human Services may be used to complete this study.

STATEWIDE EXPANSION OF CAPITATED 1915(B)/(C) BEHAVIORAL HEALTH WAIVERS(page 67)SECTION 10.24.(a) The Department of Health and Human Services Department shall select up to two additional Local Management Entities (LMEs) to implement the capitated 1915 (b)/(c) Medicaid waiver as a demonstration program during the 2010-2011 fiscal year. The waiver program shall include all Medicaid-covered mental health, developmental disabilities, and substance abuse services. Expansion of the waiver to additional LMEs shall be contingent upon approval by the Centers for Medicare and Medicaid Services.SECTION 10.24.(b) The Department shall conduct an evaluation of the capitated 1915(b)/(c) Medicaid waiver demonstration program sites to determine the programs' impact on consumers with developmental disabilities. The evaluation shall include a satisfaction survey of consumers. The Department shall consider the impact on ICF/MR facilities included in the waiver to determine and, to the extent possible, minimize potential inconsistencies with the DMA-ICF/MR rate plan and the requirements of G.S. 131E-176 and G.S. 131E-178 without negatively impacting the viability and success of the waiver program. The Department shall consult with stakeholders and evaluate all other waiver options, including the possibility of a waiver without a 1915(b)/(c) combination. The Department shall report to the House of Representatives Appropriations Subcommittee on Health and Human Services, the Senate Appropriations Committee on Health and Human Services, the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services, and the Fiscal Research Division no later than April 1, 2012, after which time the Department may expand the capitated 1915(b)/(c) Medicaid waiver to additional LMEs.The Department shall not approve any expansion of the Piedmont Behavioral Healthcare LME (PBH) beyond its existing catchment area until after the Department has completed its evaluation and made its report pursuant to this subsection.

Facebook Badge

Power of the Disability Vote!

The Arc of North Carolina 2011 Legislative Agenda.

The Arc of North Carolina advocates for and with families and people with cognitive and developmental disabilities. We believe that the following legislative agenda promotes our goals of advocacy, inclusion, and access to the communities we live in.

The Arc of North Carolina Proposed Policy Agenda 2011

Budget:

The Arc of North Carolina understands the current budget constraints that the state of North Carolina finds itself in due to the economic recession. During this critical time it is more important than ever to protect needed services for people with developmental and intellectual disabilities.We encourage the members of the General Assembly to do the following things to protect the integrity of community-based services for people with developmental and intellectual disabilities in our state.

No additional cuts to state-funded services for people with developmental disabilities.

Apply for 1915 (i) State Plan services for adults with developmental disabilities targeting supports that currently utilize state general fund appropriations and utilizing those funds a Medicaid match.

Add an additional CAP-DD Waiver for people with developmental disabilities who have significant behavioral and or medical needs.

Raise the Supports Waiver limit to 25 thousand dollars.

Utilize the Supports Intensity Scale as an initial eligibility tool for entrance into the CAP waivers with a reconsideration process utilizing other information.

Manage all of developmental disability services from a state system utilizing existing local structures where appropriate.

Housing:Fair Housing Act Amendment.

This legislation prohibits discrimination on the basis or receipt of housing assistance. Many people with disabilities receive housing assistance. This legislation if passed would assist in opening more housing opportunities to the disability community.

Education:Study ways to allow students with developmental disabilities to access current courses in our community college system. Included in this study we must look at ways to offer real job skill training to students with developmental and intellectual disabilities.

The Arc of North Carolina

Welcome to The Arc of North Carolina's official policy blog. The Arc has been serving people with disabilities for more than 50 years. In an effort to reach out to our statewide community about issues that effect us we have established this blog.

Become A Member of The Arc of North Carolina:We encourage you to become a member of The Arc of North Carolina. You can find out more about becoming a member by visiting http://www.arcnc.org/.

Visit Our Facebook Page

Join the debate. Have something to say and want quick feedback? Want to join the social networking craze? We invite you to visit and become a fan of our Facebook Page.

Contact Your North Carolina State Legislators!

Contact Congress!

About Me

Content Disclaimer

Opinions expressed on this blog are not necessarily the opinion of the The Arc of North Carolina or The Arc of the United States.The Arc of North Carolina is a non-profit and non-partisan organization. It does not endorse candidates or political parties.